Hospitals that spend more on caring for patients with sepsis do not necessarily have improved mortality, researchers suggested.

Action Points

Explain that hospitals that spend more caring for patients with sepsis do not necessarily have improved mortality, based upon a study of more than 300 hospitals.

Note that death was the only outcome examined in the study, and it is possible that hospitals with higher spending improved other factors, like quality of life, functional status, or patient satisfaction.

Hospitals that spend more on caring for patients with sepsis do not necessarily have improved mortality, researchers suggested.

In a study of 309 hospitals, the costs and mortality rates associated with sepsis varied widely -- but higher spending did not equal improved outcomes, according to Tara Lagu, MD, MPH, of Baystate Medical Center in Springfield, Mass., and colleagues.

In fact, 30 hospitals (10%) had both higher-than-expected costs and higher-than-expected mortality, whereas 22 hospitals (7%) had lower-than-expected costs and mortality, Lagu and co-authors reported in the Feb. 28 issue of Archives of Internal Medicine.

The study authors said that focusing attention on methods used by those 22 low-cost/low-mortality hospitals might help improve the management of sepsis, which affects about 750,000 patients each year in the U.S. and accounts for about $17 billion in annual costs.

"While such results highlight potential opportunities to improve the value of care, they do not offer a specific prescription for change," Lagu and colleagues wrote, adding that enhanced coordination of care might play a role.

"Hospitals that are better able to standardize and coordinate the care of patients with sepsis may perform fewer procedures and diagnostic tests, mandate use of the most cost-effective therapies, and minimize the time patients spend in the intensive care unit, resulting in lower costs without adversely affecting patient outcomes," they wrote.

For their study, the researchers performed a cross-sectional analysis of 166,931 patients treated for sepsis at 309 hospitals participating in the Perspective database (a voluntary, fee-supported database created to measure quality and healthcare utilization).

The patients had been treated between June 1, 2004 and June 30, 2006 and all had antibiotic treatment started within the first two days of hospitalization.

The median age of the patients was 70, and most (63%) were covered by traditional Medicare plans.

Overall, 20% of the patients died in the hospital. The median expected mortality rate was 19.2%, based on patient characteristics and comorbidities and the need for admission to the ICU, mechanical ventilation, and vasopressors.

The median expected cost per patient was $18,659.

There was wide variation in both cost and mortality rates among the hospitals.

Of the hospitals close to median expected mortality, the actual death rate ranged from 9.2% to 32.3%.

And of the hospitals close to the median expected cost, actual costs per patient ranged from $12,271 to $37,095.

After accounting for hospital-level characteristics, the researchers did not find a significant association between hospital spending and mortality rates.

Consistent across the spectrum of spending, room and board contributed half of all costs. Laboratory testing, diagnostic imaging, and pharmacy were also major contributors.

Hospitals that spent the most on sepsis care remained at the top of the list even after accounting for differences in length of stay (P<0.001), although a look a spending patterns did not provide an explanation of the disparity.

According to the researchers, the finding that some hospitals have lower-than-expected costs and mortality rates provides an opportunity to improve the value of sepsis care by cutting costs without reducing the quality of care.

They acknowledged several limitations to their study, including the use of claims data voluntarily submitted by hospitals for the purposes of quality improvement, the identification of cases using diagnostic codes, blood cultures, and treatment with antibiotics, as well as the exclusion of transferred patients, and the inability to account for variability of care within hospitals.

In addition, death was the only outcome examined in the study, and it is possible that hospitals with higher spending improved other factors, like quality of life, functional status, or patient satisfaction.

The study was conducted with funding from the Division of Critical Care and the Center for Quality of Care Research at Baystate Medical Center. Premier Healthcare Informatics provided the data used to conduct the study. One of the study authors is the recipient of a clinical scientist development award from the Doris Duke Charitable Foundation.

Lagu reported that she had no conflicts of interest. One of her co-authors has received research grant support from and participates in the lecture bureau of Eli Lilly & Company. Another author, through his company OptiStatim, was paid by the investigators with funding from the Department of Medicine at Baystate Medical Center to assist in conducting the statistical analyses in this study.

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